Postoperative lung complications and mortality in patients with mild-to-moderate COPD undergoing elective general surgery

Objective: To verify the incidence of postoperative pulmonary complications (PPC) and mortality in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) who undergo elective general surgery. Incidence of PPC and mortality were studied in relation to sex, age, anesthesia, surgic al incision, duration of surgery, smoking, respiratory symptoms, comorbidit y, nutritional status, lung examination, abnormal electrocardiogram, and Pa O2, PaCO2, FEV, and FEV1/FVC. Design: Prospective, open study. Material and methods: Fifty-nine COPD patients were enrolled (FEV1/FVC < 88 % of reference for women and < 89% for men) and studied at a tertiary care university hospital. The patients were examined during the preoperative per iod and followed until discharge. Results: Twenty patients (33.9%) experienced PPC and 6 died, two (3.4%) fro m lung-related causes. Thirty-five PPC events occurred: pneumonia (37.2%), bronchospasm (22.9%), atelectasis (11.4%), acute respiratory insufficiency (11.4%), prolonged mechanical ventilation (11.4%) and bronchial infection ( 5.7%). Risk factors for PPC were male gender, duration of surgery over 270 minutes, low FEV1/FVC (71.9 +/- 10.9%) and surgical incision in the chest o r upper abdomen. No significant difference between patients with or without PPC were found for age, presence of respiratory symptoms, comorbidity, abn ormal lung examination, nutritional status, smoking, abnormal electrocardio gram, PaO2, PaCO2, FEV1 or duration of pre-operative hospitalization. The r ate of PPC was higher in patients smoking more than a mean 40 packs of ciga rettes per year. Patients with PPC had longer hospital stays (16.6 +/- 15.0 vs. 7.5 +/-5.7 days) and stayed longer in intensive care units (7.0 +/-5.9 vs. 1.7 +/-0.7 days) than did those with no complications (p<0.05). Conclusions: The incidence of PPC was 33.9% and lung-related mortality was 3.4%. Risk factors were male gender, amount of smoking, duration of surgery over 270 minutes, low FEV1/FVC, and chest or upper abdominal incision. No risk factor was found to predict mortality in this group.